Breast lump: Early evaluation is essential

If you find a breast lump or other change in your breast, you may be worried about breast cancer — but take comfort in the odds. As many as 4 out of 5 breast lumps that are biopsied are noncancerous (benign). Still, it's important to have any breast lump evaluated by a doctor.

How breast tissue normally feels

Breasts contain tissues of varying consistency. Glandular tissue — primarily felt in the upper, outer part of the breast — usually feels firm and slightly rope-like, bumpy or lumpy (nodular). Surrounding fat tissue — often felt in the inner and lower parts of the breast — is soft. You may find that breast-related symptoms, such as tenderness or lumpiness, differ over the course of your menstrual cycle. Breast tissue also changes as you age, typically becoming more fatty and less dense over time.

When to consult a doctor

Familiarity with your normal breast consistency will help you determine if there's a change in your breasts. Consult your doctor if:

• You find a breast lump that's new or unusual and feels different from breast tissue in either breast
• A new breast lump doesn't go away after your next period
• A breast lump seems to have changed — it gets bigger, for instance
• You have bloody discharge from your nipple
• You notice skin changes on your breast, such as redness, crusting, dimpling or puckering
• Your nipple suddenly turns inward (inversion)

Nipple changes

Nipple changes

Breast and nipple changes can be a sign of breast cancer. Make an appointment with your doctor if you notice anything unusual. ...

What to expect during a clinical breast exam

Evaluation of a breast lump typically begins with a clinical breast exam. During this exam, your doctor will likely:

• Ask about any symptoms and your risk factors for breast cancer or benign breast conditions
• Look at your breasts, noting their shape and size
• Observe the condition of the overlying skin on your breasts
• Check for nipple problems, such as inversion or discharge
• Feel deeper tissue in your breasts and armpits for lumps, prominent nodular areas or areas of thickening

If your doctor confirms that you have a breast lump or other area of concern, you'll likely need testing to determine what's causing the problem.

Other tests and procedures to evaluate a breast lump

To further evaluate a breast lump, your doctor may recommend one or more of the following tests or procedures.

Fine-needle aspiration
During fine-needle aspiration — which may be done during an office visit or through a referral to a surgeon or radiologist — a thin, hollow needle is inserted into the lump and any fluid is removed (aspirated). Your doctor may use ultrasound, a procedure that uses sound waves to create images of organs and tissues, to guide the needle placement and aspiration.

If the lump contains nonbloody fluid, it's most likely a benign cyst and will probably disappear with aspiration. If the lump contains bloody fluid, the fluid will be sent to a lab for analysis and you'll likely need more testing to determine whether it's cancer. Similarly, if the lump doesn't contain fluid, you'll likely need more testing to determine whether it's cancer.

If your doctor does the fine-needle aspiration without ultrasound guidance and the breast lump disappears, he or she will probably ask you to come back for a follow-up exam in four to six weeks. If the breast lump returns during that time, you'll need more testing.

Ultrasound
During an ultrasound, sound waves are used to create images of your breast. If the breast lump isn't painful and the ultrasound confirms that it's a cyst, you may not need aspiration. If the breast lump hurts, your doctor may use ultrasound to guide fine-needle aspiration — which can relieve pain. If ultrasound reveals that the lump is solid, your doctor may use a needle to collect a small amount of breast tissue (biopsy) for lab analysis.

Mammogram
A diagnostic mammogram — a specialized breast X-ray — helps your doctor investigate breast lumps and other signs and symptoms, such as nipple discharge. Unlike a screening mammogram, which is done when there are no particular breast concerns, a diagnostic mammogram provides views at higher magnification from several angles and focuses on the area where the lump is located. This can help your doctor precisely locate and determine the size of the lump or abnormality. If your doctor suspects cancer, you'll likely need a needle biopsy and possibly surgery.

Depending on your age, your doctor might use ultrasound to make a diagnosis — either alone or in conjunction with mammography. Because a younger woman's breasts are denser than are an older woman's breasts, a mammogram on a younger woman can be more difficult to interpret. In general, if you're younger than age 35, ultrasound may be the only imaging test ordered. If you're age 35 or older, your doctor will likely order a diagnostic mammogram and an ultrasound of the breast lump.

Magnetic resonance imaging
Magnetic resonance imaging (MRI) is an imaging test that uses magnetic energy rather than X-ray. If diagnostic mammogram and ultrasound results are normal but the clinical breast exam reveals an area of concern, an MRI may be helpful. However, an MRI takes longer to perform than other imaging tests and involves the intravenous injection of dye to help differentiate between benign and cancerous breast lumps. Cancerous tissue requires a greater blood supply than does normal tissue. Because MRI images show greater contrast in areas of increased blood supply, a radiologist can use the images to tell which areas may or may not be cancerous. MRIs can also be difficult to read, causing a false-positive or the need for additional testing.

Breast biopsy
If the breast lump is solid, your doctor may use one of the following procedures to take a tissue sample:

• Fine-needle aspiration biopsy. During fine-needle aspiration, a special needle is used to collect a tissue sample. This procedure can be done in the office or by a radiologist with ultrasound guidance.
• Core needle biopsy. During a core needle biopsy, a larger needle than used with fine-needle aspiration is used to obtain a small, solid core of tissue. This procedure may be done in the office or by a radiologist with ultrasound guidance.
• Stereotactic biopsy. This is another type of needle biopsy, in which mammography is used to pinpoint an abnormal area that shows up on a breast-imaging test but isn't felt during a clinical exam or seen on ultrasound. This technique uses stereo images — images of the same area obtained from different angles — to locate the area of concern. Then a sample of breast tissue is removed through a hollow needle.
• Vacuum-assisted biopsy. During a vacuum-assisted biopsy, a small cut is made in the skin and a hollow probe connected to a vacuum is used to remove tissue from an abnormal area. This procedure may be done in the office or by a radiologist with ultrasound guidance.
• Surgical biopsy. With this type of biopsy, the entire breast lump as well as some surrounding breast tissue is removed for analysis (excisional biopsy). If the lump is too large to be removed easily, only part of the lump is removed (incisional biopsy).

After any type of biopsy, the tissue sample is sent to a lab for analysis. Results are typically available within a week.

Fine-needle aspiration

Fine-needle aspiration

In fine-needle aspiration, your doctor inserts a thin, hollow needle into your breast and draws fluid out of the lump with a syringe. ...

Core needle biopsy

Core needle biopsy

A core needle biopsy uses a long, hollow tube to extract a core of tissue. Here, a biopsy of a suspicious breast lump is being done. The core is sent to a laboratory for testing. ...

Follow-up after breast lump evaluation

If the breast lump doesn't seem to be cancerous, your doctor may suggest monitoring the area for a few months. See your doctor right away for re-evaluation of the breast lump if you notice any changes or develop any new areas of concern.

If the diagnosis is in question — the clinical breast exam and the mammogram show areas of suspicion, for example, but the pathology report from the biopsy reveals benign tissue — you may be referred to a surgeon or other specialist for further consultation.

If the breast lump is cancerous, you'll work with your doctor to create a treatment plan. The stage of breast cancer, along with its type, will determine your treatment options. If you're unsure how to proceed, ask your doctor to help you make the best treatment decisions.

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